Zhao Jinyang, Dong Liang, Jiao Xue, Xia Fan, Shan Qi, Tang Jiawen, Wang Sihan, Lyu Xiaohong
Radiology Department, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China (J.Z., F.X., Q.S., J.T., S.W., X.L.).
School of Electrical Engineering, Liaoning University of Technology, Jinzhou, China (L.D.).
Acad Radiol. 2025 May;32(5):3006-3022. doi: 10.1016/j.acra.2025.01.006. Epub 2025 Jan 25.
Severe COVID-19 typically results in pulmonary sequelae. However, current research lacks clarity on the differences in these sequelae among various clinical subtypes. This study aimed to evaluate the changing lung imaging features and predictive factors in patients with COVID-19 pneumonia in northern China over a 12-month follow-up period after the relaxation of COVID-19 restrictions in 2022.
Imaging and clinically relevant data from three groups (moderate, severe, and critical) of patients with varying severity were prospectively analyzed. Low-dose CT scans were conducted at 3, 6, and 12 months after discharge, with chest CT images evaluated at baseline and each follow-up using qualitative and quantitative analyses. Clinical symptoms and pulmonary function recovery at 12 months were documented. The correlation between lung function and CT results was analyzed. Univariate and multivariable logistic regression analyses were employed to examine factors influencing prognosis, while a post-hoc analysis model was utilized to investigate the relationships among different groups, time points, and chest CT findings.
Among the 103 hospitalized patients with COVID-19 pneumonia, 64 completed the 12-month evaluation. The median age was 63.70 ± 12.15%, and 62.5% (40/64) were men. During the follow-up period, while 67.19% (43/64) showed abnormalities, including fibrotic changes in 9.38% (6/64). Multivariable logistic regression identified age ≥ 65 (OR: 8.66; 95% CI: 1.86, 40.34; P = 0.006), length of hospital stays (OR: 1.23; 95% CI: 1.03, 1.47; P = 0.022), and baseline consolidation volume as a percentage of the whole lung (OR: 56.95; 95% CI: 1.198, 2706.782; P = 0.04) as independent risk factors for persistent CT lung abnormalities at 1 year. After 1 year, 34.38% (22/64) of patients still had abnormal lung function, and 9.38% (6/64) had pulmonary fibrosis and restrictive ventilatory dysfunction. The relationship between lung function and CT findings is weak correlation. The mixed model analysis revealed significant differences between groups, particularly between the moderate and severe groups, and significant changes in CT values over time.
One year after infection, more than one third of even moderate patients with mild symptoms had persistent pulmonary abnormalities. In our study, fibrotic changes were seen in severe and critically ill patients and remained stable 6 months after discharge from hospital. Imaging parameters can predict the prognosis. The larger the extent of baseline consolidation, the worse the prognosis of elderly patients.
重症新型冠状病毒肺炎（COVID-19）通常会导致肺部后遗症。然而，目前的研究对于这些后遗症在不同临床亚型中的差异尚缺乏清晰认识。本研究旨在评估2022年COVID-19限制措施放宽后，中国北方COVID-19肺炎患者在12个月随访期内肺部影像特征的变化及预测因素。
前瞻性分析了三组病情严重程度不同（中度、重度和危重症）患者的影像及临床相关数据。出院后3个月、6个月和12个月进行低剂量CT扫描，在基线及每次随访时使用定性和定量分析评估胸部CT图像。记录12个月时的临床症状及肺功能恢复情况。分析肺功能与CT结果之间的相关性。采用单因素和多因素逻辑回归分析来检验影响预后的因素，同时利用事后分析模型研究不同组、时间点及胸部CT表现之间的关系。
103例住院的COVID-19肺炎患者中，64例完成了12个月的评估。中位年龄为63.70±12.15%，男性占62.5%（40/64）。随访期间，67.19%（43/64）患者存在异常，其中9.38%（6/64）有纤维化改变。多因素逻辑回归确定年龄≥65岁（OR：8.66；95%CI：1.86，40.34；P = 0.006）、住院时间（OR：1.23；95%CI：1.03，1.47；P = 0.022）以及基线实变体积占全肺的百分比（OR：56.95；95%CI：1.198，2706.782；P = 0.04）为1年后CT肺部持续异常的独立危险因素。1年后，34.38%（22/64）患者肺功能仍异常，9.38%（6/64）有肺纤维化和限制性通气功能障碍。肺功能与CT表现之间的关系为弱相关。混合模型分析显示组间存在显著差异，尤其是中度和重度组之间，且CT值随时间有显著变化。
感染1年后，即使是症状较轻的中度患者中也有超过三分之一存在持续的肺部异常。在我们的研究中，纤维化改变见于重症和危重症患者，出院后6个月仍保持稳定。影像参数可预测预后。基线实变范围越大，老年患者预后越差。
